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[Ulcerative colitis caused by Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome]
Abstract:
The authors report a case of ulcerative colitis due to Histoplasma capsulatum in a previously healthy 35 year-old french geologist with acquired immune deficiency syndrome (AIDS). Gomori-Grocott and PAS stains and indirect immunofluorescence revealed Histoplasma capsulatum in colonic biopsies. The search for LAV antibody was positive. T-lymphocyte analysis revealed 10/mm3 OKT4 with OKT4/OKT8 ratio of 0.16. Histoplasmosis should be considered in subjects with ulcerative colitis according to the epidemiological context. In patients with AIDS relapses after discontinuation of treatment are to be expected and suppressive therapy with an imidazole derivative should probably be continued indefinitely.
Insights
Histoplasma capsulatum can cause ulcerative colitis in individuals with acquired immune deficiency syndrome (AIDS). Long-term antifungal therapy is recommended for AIDS patients with histoplasmosis to prevent relapses.
Area of Science:
- Mycology
- Infectious Diseases
- Gastroenterology
Background:
- Acquired immune deficiency syndrome (AIDS) compromises the immune system, increasing susceptibility to opportunistic infections.
- Ulcerative colitis is a chronic inflammatory bowel disease with various potential etiologies.
- Histoplasma capsulatum is a fungus that can cause disseminated infections in immunocompromised individuals.
Observation:
- A previously healthy 35-year-old French geologist with AIDS presented with ulcerative colitis.
- Colonic biopsies revealed Histoplasma capsulatum via Gomori-Grocott and PAS stains, and indirect immunofluorescence.
- LAV antibody testing was positive, and T-lymphocyte analysis showed significantly reduced OKT4 cells (10/mm3) with a low OKT4/OKT8 ratio (0.16).
Findings:
- The case demonstrates a rare presentation of ulcerative colitis caused by Histoplasma capsulatum in an AIDS patient.
- Diagnostic confirmation relied on histopathological examination of colonic biopsies and serological markers for HIV (LAV antibody).
- Severe T-cell depletion (OKT4) was noted, consistent with advanced HIV infection.
Implications:
- Histoplasmosis should be considered in the differential diagnosis of ulcerative colitis, particularly in patients with relevant epidemiological risk factors and immunosuppression.
- Patients with AIDS and histoplasmosis are at high risk for treatment relapses after discontinuation of therapy.
- Indefinite suppressive therapy with imidazole antifungals is likely necessary to manage disseminated histoplasmosis in AIDS patients and prevent recurrence.